Healthcare: Challenges are too many

Bangladesh with one of the highest population density and meagre resources faces a lot of challenges in ensuring a minimum of healthcare facilities. Since its birth, it has been struggling hard to overcome many challenges in its task of improving infrastructures and providing services. Long 45 years after independence, its achievements in reducing infant and child mortality rates, increasing immunisation coverage and improving life expectancy can be termed impressive. Whatever improvements in the health service sectors are visible, credit in most cases due to non-government organisations (NGOs) and private sector. With their models and approaches, the government was able to reach health services to targeted groups including hard to reach ones.
Still, Bangladesh is recognised as the country having problems such as high maternal mortality, chronic malnutrition, very low per capita health expenditure and many more. Its challenges are also high in the cases of many communicable and non communicable diseases.
According to latest data available with the Directorate General of Health Services (DGHS), the life expectancy in Bangladesh is now recorded 68.3 years which was 44 years in 1970. Under-5 mortality rate in per 1000 birth has come down remarkably. Coverage of immunization was only 1.0 per cent at the beginning of the independence which has increased to 80 to 90 per cent of the population in many cases. The situation is the underweight children under five, maternal mortality rate, birth attended by skill health personnel have also improved.
However, data do not depict real picture of a situation. The World Bank's data show health sector per capita expenditure increased to only US $ 35 during 2011-15 from $ 26 during 2005-10.
According to official data, out of 1000 births 36 still-birth take place in the country. Only 25 to 30 per cent birth are attended by skilled health personnel. Scope of improving institutional delivery coverage rate and births attended by skilled health personal could be increased. The government is yet to ensure cent per cent coverage of families by skilled health professionals at least once in a year.
Acording to the DGHS, bulletin 2015, of the total 708,196 deliveries reported from the government health facilities, 0.7 per cent took place in a postgraduate institute hospital (ICMH), 13.9 per cent in medical college hospitals, 15.3 per cent in district and general hospitals, and the largest proportion -- 71.1 per cent took place at the government health facilities at the upazila level.
Besides, data underlines the complexity of malnutrition, where poverty and hunger, low rates of breastfeeding, inadequate care and complementary feeding, and recurrent infections come as factor. Recently obesity has also become a health problem in many urban areas.
In the case of institutional development, the data show more than 600 government hospitals of secondary and tertiary levels are now providing services under the DGHS. Nearly 500 government hospitals are operational. But the number of private registered hospitals and clinics is nearly 10,000 where people in both rural and urban areas take much for their health service. Number of hospital beds, ratio of doctor patient, doctor nurses etc are not at all encouraging in the country.
According to the DGHS, number of hospital beds in private hospitals is around 75,000 which is five times more than the beds provided by the public hospitals. However, what is more painful is that there is one bed for 1300 people in the country. One physician for more than 2600 people, one nurse for 8600 people and one medical technologist for 26,490 people and one community health worker for 2500 people.
All these data highlight the reality that more than 133 post graduate medical institutions and colleges of government and private level could not cover the need of the population for medical personnels and staff.
At present, there are 33 postgraduate medical teaching institutions in the country including 23 government ones. The number of medical colleges is now 100. Besides, the government has dental colleges, nursing colleges, junior mid wifery training centres, health technology.
Whatever the facilities have been installed and services introduced, people sufferings in getting health services have not reduced in the country. People living in remote areas do not get doctors in their local health centres and hospitals, expensive medical equipment often go out of order, middlemen control medicine supply chain leading people to buy at higher cost. Middlemen in government hospitals reign supreme. But the private hospitals are forcing people to spend more than fortified amount in the name of modern technology and services. Inexperienced and inefficient doctors, nurses and diagnostic services still traumatize people when they are sick. Scenario of hospitals whether it is government or private or in rural or urban areas is not anyway different.